What Is the Annual Election Period (AEP)?
The Annual Election Period (AEP) runs October 15 – December 7 each year. During this window, Medicare Advantage (MA) and Prescription Drug Plan (PDP) members can join, leave, or change plans. New elections generally take effect on January 1. Review your Annual Notice of Change (ANOC) to see updates to your current coverage.
If You Miss AEP
If you miss the AEP deadline, you may still make one change during the Open Enrollment Period (Jan 1 – Mar 31): switch to another MA plan (with or without drug coverage), or disenroll to Original Medicare (Parts A & B) and enroll in a standalone Part D plan. Medicare Supplement enrollees generally must wait unless they qualify for a Special Enrollment or a 5-star plan that accepts year-round enrollment.
Happy With Your Current Plan?
If your plan still fits your needs and remains available, no action is required—you’ll roll over automatically. If your insurer discontinues your plan, you’ll need to choose a new one by December 7.
Why Review Annually
- Premiums & copays can change.
- Drug formularies (covered meds & tiers) may be updated.
- Dental/vision/OTC or other allowances can increase or decrease.
Your health needs evolve—confirm your plan still aligns with your medications and providers.
Medicare Supplement vs. Medicare Advantage
| Feature | Medicare Supplement | Medicare Advantage (MA) |
|---|---|---|
| Network | Any provider that accepts Medicare | Plan network (HMO/PPO/HMO-POS) |
| Premium | Monthly premium required | Often $0 or low-cost options |
| Extra Benefits | Generally medical only | May include dental, vision, hearing, fitness, OTC |
| Out-of-Pocket Max | No annual cap | Annual maximum out-of-pocket (MOOP) |
Enrollment across Supplement vs. Advantage is roughly split. MA plans can bundle extra benefits (e.g., dental/vision, gym, meals after inpatient/observation stay) and include an annual out-of-pocket maximum, sometimes with $0 premiums.
PrimeTime Health Plan (HMO-POS) Highlights
- Broad network including Aultman, all Cleveland Clinic facilities (including Florida), and University Hospitals—50+ hospitals in total.
- Dental: reimbursed amount up to $1,250.
- Vision: $0 routine exam + $300 eyewear allowance.
- Fitness: SilverSneakers® membership included.
- Post-discharge meals: up to 10 meals after inpatient/observation stay.
- OTC: up to $400/year allowance.
- Worldwide: urgent & emergency coverage (copay applies).
PrimeTime Health Plan is an HMO-POS with a Medicare contract; enrollment depends on contract renewal.
Understanding Part D Prescription Coverage (2025–2026)
Part D can be included with an MA plan or purchased standalone with Original Medicare. Due to the Inflation Reduction Act, the former “donut hole” coverage gap has been eliminated. For 2026, the three stages are:
- Deductible Stage – you pay 100% until the deductible is met.
- Initial Coverage – you pay copays/coinsurance until $2,100 out-of-pocket.
- Catastrophic – after $2,100 OOP is reached, covered drugs are paid 100% for the rest of the year.
Formularies and drug tiers vary by plan (e.g., the same medication can be Tier 1 with $0 copay in one plan and Tier 2 with a small copay in another). Some members may qualify for help (VA, Extra Help/LIS, Medicaid), and carriers may offer budget-friendly payment options to spread costs across the year.
Example: Original Medicare vs. PrimeTime HMO-POS
- Original Medicare has deductibles and 20% coinsurance for many Part B services—and no annual MOOP.
- PrimeTime HMO-POS uses predictable copays that apply toward an annual MOOP (after which covered services are paid 100% for the remainder of the year).
Why Some Switch from Supplement to Advantage
- Lower premiums (often $0 MA options)
- Bundled Part D drug coverage
- Extra benefits like dental, vision, OTC, meals, fitness
- Simplified experience with a single plan/ID card
Evaluate network fit, medication coverage, travel needs, and your expected healthcare usage before deciding.
Learn More or Enroll
PrimeTime Health Plan (HMO-POS)
- Call: 330-363-7407 or 1-800-577-5084 (TTY 711)
- Website: www.pthp.com
- Walk-in Hours: Mon–Fri, 8:00 a.m. – 4:30 p.m. (Oct 1–Mar 31: 7 days/week, 8:00 a.m. – 8:00 p.m.)
- Address: 2600 6th St SW, Canton, OH
You can enroll online at pthp.com or via Medicare.gov, submit a paper form by mail, drop it off at the office, or work through a licensed agent/broker.
Tune In
Join us on Health Matters Radio on Friday, October 24, 2025, for the full conversation with Trisha Witts from PrimeTime Health Plan.
Watch a replay of our YouTube Livestream here
Thanks for listening today! We’d like to remind our listeners, if you suspect you have a medical issue, please contact your healthcare provider. Thanks to our sponsor Aultman Health System. As always, we thank our listeners for joining us on Health Matters with the Medicine Center Pharmacy. Have a healthy week and we’ll see you again next Friday right here on News Talk 1480 WHBC.
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